Research on the use of guidelines in the care of critically ill patients has shown that when interventions are provided early and accurately they can result in increased survival, decreased morbidity and overall cost savings. It has also been shown that even well documented and nationally supported guidelines for care are not used routinely or consistently with patients. The long-term goal of this grant "Clinical Research to Bedside Care: Evidence and Tools for Improving Critical Care" is to evolve the Center for Excellence in Critical Care's very successful industry sponsored Update in Critical Care symposia into a two-day program that serves as an agent for change in critical care practice. Aim 1 of the grant is to provide a series of programs on quality improvement and changing culture: the 2008 program will be subtitled "Changing culture: adoption of guidelines, improved safety and outcomes" the 2009 program will be "Creating a culture of safety, measuring change and continued improvement" and the 2010 program will be "Maintaining a Culture of Quality". Conferences will build on the previous year's experience. Aim 2 is to build change agent teams in institutions: teams of physicians, nurses, pharmacists, respiratory therapists, EMT, hospital administrators and quality improvement officers from the smallest rural hospital to the largest level 1 centers will be invited to hear the impact of applying evidence-based guidelines on mortality, morbidity, length-of-stay and cost. The first day of the conference will provide recent findings in the treatment of the critically ill. The second-day of the conference will address why, even when there is significant evidence of their positive impact, guidelines and protocols are not common in practice and will offer strategies for overcoming the barriers to implementing guidelines. Aim 3 is to provide enduring materials including conference proceedings on CD and the Center website for subsequent institutional training. Aim 4 is to create a network of area resources for quality improvement. Regional hospitals will be invited to present their quality improvement successes at poster sessions or workshops. The conference planning committee will include area leaders and institutions willing to participate in making this conference meet their quality improvement needs. An invitation to participate in research collaborations and data collection that measures change will be extended to participating teams. This innovative program transitions a successful but traditional critical care education program into a change agent for quality improvement uniquely targeting all levels of practitioners, hospital sizes and locations and develops a network for research collaboration through the process of critical care quality improvement.